Forward thinking: Bathing and lift equipment improvements are worth the price, even in a recession

Forward thinking: Bathing and lift equipment improvements are worth the price, even in a recession

Given the current economic climate, many skilled nursing operators have become increasingly focused on streamlining operational efficiencies and tightening the belt on capital equipment spending.While such an approach is certainly understandable—and often prudent—there are times when factoring in equipment improvements into the budget can pay off with big dividends.

Bathing and lift systems are two prime examples. These days, it's not just about being able to perform the basic task at hand but also about making the bathing or lifting experience safer and more enjoyable—for residents and staff—while maximizing available resources. Meeting those goals isn't just a good move from an operational and risk management perspective; it's also becoming increasingly important on the regulatory front.

One bill, H.R. 2381, which is currently in committee, calls for an occupational safety and health standard geared toward safe patient handling and injury prevention of patients and caregivers.

“With efforts such as this, both caregivers and staff can be assured that procedures will be in place [to enhance] both their comfort and safety,” says Scott Maurus, product manager for ArjoHuntleigh of Addison, IL.

More than ever, equipment manufacturers are offering a slew of standard features and add-on accessories that can meet those safety requirements while also driving added value and a rapid return on investment.

Even better news? Various features are far more cost-effective than one might expect and, in some cases, can help facilities get more mileage from their existing equipment.

Moving beyond basics

Facilities looking to build upon bathing system basics will find an array of features and accessories available to help them customize the equipment and meet the varying needs and preferences of their residents and staff.

Adjustable height tubs, which reduce back strain in staff and create a more comfortable resident transfer, are one option that has become increasingly popular in recent years.

“In the past, tubs were made very high off the ground so as not to strain the caregiver's back while bathing [the resident]. The problem with this was the resident had to be lifted very high in the air on the lifter to get into the tub,” explains Kari Harbaugh, associate product manager of Milwaukee, WI-based Direct Supply. “It was a scary experience for residents. These tubs often went unused in the facilities shortly after they arrived. With many recumbent tubs now, customers are able to order it with a height-adjustable option, allowing the tub to be in a low position for a transfer, then raised to a safe working height once the resident is safely inside.”

Modern bathing systems also are being built with added efficiency in mind. Rapid-fill, heated reservoirs, for example, make it possible to start the bathing process even before the resident is ready. They can significantly reduce the time spent waiting for the tub to fill.

“Once the resident is in the tub, temperature-controlled water in the reservoir fills the tub in about 90 seconds. Other tubs without reservoirs can take 10 minutes or more to fill. These long waits waste staff time and make residents uncomfortable, and possibly, combative,” notes David Anderson, product manager, Apollo Bath of Somerset, WI.

The reservoir automatically refills during a bath, so a fresh supply of water is ready and waiting for the next resident. Because Apollo's bathing systems are modular in design, the Rapid Fill reservoir option, which generally sells for under $3,900, can easily be added at a later date.

“If a facility is on a tighter budget, it may make sense to start with a basic air spa bathing system and then build from there as budgets [allow],” Anderson said. But if a facility bathes a large number of residents per day—10 to 15 per shift or so—then the reservoir could offer a rapid return on investment, he added, noting “especially if a facility has low water pressure and has to wait a long time for the tub to fill for each resident.”

Designer effects

Water conservation is also possible, thanks to innovative tub designs that can effectively and comfortably bathe residents with less water. The semi-reclining design of ArjoHuntleigh's Parker tub, for example, uses only 25 gallon of hot water— half of what is used in traditional bathing system designs, according to Maurus.

Meanwhile, bathing system vendors are stepping up their efforts with improved, user-friendly disinfection systems. The new-and-improved disinfection systems encourage staff to clean the tubs properly, which extends the life of the tub and keeps bathing healthy and more enjoyable for residents, according to Harbaugh.

“Most tubs I've come across come with a disinfection system,” but facilities should recognize that some “value” tubs might not offer such a feature, she said.

Ultraviolet water purification is another option, albeit one that might be better suited to facilities with bigger budgets and those looking to adopt cutting-edge systems that can give them a competitive advantage.

“It is well documented that traditional air spas and whirlpools produce an aerosol effect that can disperse bacteria into the air,” Anderson notes. “Facilities benefit because the resident population stays healthier, less staff time is spent providing remedial care, and the bathing process takes less time than with other bathing systems. This all positively affects the bottom line.”

Apollo's Remedy ultraviolet purification system lists for well under $2,000 when ordered initially as part of a bathing system. Because the design of the tub is modular, however, a facility may add the UV system to any Apollo Advantage series bathing system at a later date as part of a retrofit kit.

“The system can pay for itself in saved time within the first few months of operation,” Apollo Bath's Anderson added.

If pressure reduction, support and comfort are a top priority, facilities can easily meet that goal—even with their existing tubs—by layering the basin or bathing seat with a waterproof cushion. Bath cushions, padded footrests and supports can cost anywhere from $50-$200, depending on the size, configuration and material, and can be easily removed or adjusted to meet residents' varying needs.

Visionary features

One Baltimore-based geriatric care facility recognizes that the next generation of residents will be looking for more sophisticated bathing areas and accessories. Tub-integrated televisions are one accessory that has caught the facility's attention.

“Some of our people really liked that feature, but it is very expensive,” says Mary Ellen Lindenmuth, RN, performance improvement and safety specialist for Levindale Hebrew Geriatric Center and Hospital. One solution, she says, might be to incorporate a separate, flat-panel monitor in the bathing area. “It would accomplish the same thing, only for much less [money].”

Levindale is also looking at handheld shower attachments to allow more independent residents to play a more active role in the bathing process.

Thinking even bigger, Levindale is currently involved in a building project that will offer private resident rooms with their own side-entry baths—as well as a shared bathing area with a whirlpool bath and ceiling lift.

Lifts reach new heights

Because lifting residents into the tub remains one of the most challenging tasks for caregivers— and among the least favorite for residents, as well—finding lifting and transport equipment that can make the task safer, more secure and comfortable is essential, sources note.

Long-term care operators with bigger capital equipment budgets may want to consider corresponding tub lifts, which can range from roughly $500 to nearly $2000, depending on the model. These may be sold as an add-on if an operator chooses to defer purchase.

Long-term care operators with bigger capital equipment budgets may want to consider corresponding tub lifts.“Tub lifters are designed to integrate the tubs for easier use. For a side entry tub, for example, the lifter allows you to use this tub for any resident, ambulatory or non-ambulatory, as long as the resident can [support their own trunk],” Harbaugh said, adding that the tub lift will reduce the number of transfers needed during bathing, thereby increasing safety for residents and staff.

Fewer transfers also translate into longer equipment and battery life. Still, some vendors are doing their part to keep the total cost of ownership down by offering inexpensive replacement components and repair options. Aurora, NE-based Vancare Inc., for example, uses common batteries in its lifts that can be found for about $35 at local battery stores, as opposed to specialty batteries that can cost several hundred dollars.

“It's very important that facilities know the total cost of ownership with their equipment. Batteries have a maximum life of about three years, so the cost to replace them needs to be factored in,” says Vancare Vice President Pat Vanderheiden. “Other things will happen, too, such as cracked or broken hand controls and cut cords, so it's important to know how those things can be fixed and how much it will cost.”

Weighing options

As long-term care providers are having to do more with less, several manufacturers of bathing and lifting equipment are designing their equipment to do just that. Offering lifts with integrated scales is one example.“The obvious benefit to this feature is it eliminates an additional transfer [because] the resident can be lifted and weighed at the same time,” said Brooks Smith, president of Medcare Products Inc., of Burnsville, MN.

Another benefit, according to Apollo Bath's Anderson, is that integrated weigh scales can eliminate the need for traditional scales. These integrated scales increase the accuracy and consistency of weights measured.

Apollo Bath's mobile digital scale attaches to the frame of its bathing unit's transfer system and can be easily added as facility budgets allow.

Southampton Estates, an ACTS retirement community near Philadelphia, appreciates the efficiency of having both total lifts and sit-to-stand lifts with integrated scales. Aside from eliminating the need for separate weighing, the built-in lift scale also ensures that staff use the proper slings.

“If you use a sling that's too big or too small, that will, of course, compromise safety and comfort. When you can get the current weight right then and there, that takes the guesswork out of choosing the right sling to suit that resident's weight,” explains Kari Gansky, assistant director of nursing for Southampton Estates.

Having a wide selection of slings in varying materials and sizes (including child sizes for slight-statured residents) is equally important. Unfortunately, some facilities invest thousands in the lift equipment itself, but then fail to invest in enough slings to ensure that the lifts are used properly, experts note.

“Aides are already pressed for time. They aren't going to be able to spend time wandering around the facility looking for a sling. If there aren't enough slings available, the lifts will be sitting there unused,” stresses Ray Miller, director of risk and safety solution for Direct Supply.

Skilled nursing operators will be pleased to learn that slings are as varied and customizable as the lifts themselves. Therefore, they can go a long way toward enhancing comfort and resident peace of mind. Four-point hanger assemblies, for example, allow slings to comfortably adapt to the unique size and shape of a resident, as opposed to traditional fixed-width slings that offer no “give” and can create discomfort during transfer.

“The price for a four-point hanger assembly is not much different than [for a fixed-width sling],” says Vanderheiden.Custom-designed slings and belts allow facilities to tailor the devices to the specific needs of their unique residents—including amputees, who might feel vulnerable in a traditional sling, he adds.

Vendors also are offering incontinence slings with moisture-resistant material and, in some cases, antimicrobial protection. Gansky said Southampton Estates uses special slings with plastic liners for its incontinent residents, which prevent odor from being trapped in the material and make clean-up a snap.

“It's been terrific from an infection control perspective,” she said.

Some floor lifts also are being designed with low-profile wheels and antimicrobial-impregnated plastic components—and greener materials will be the wave of the future, predicted Brooks.

Careful assessing needed

As innovative as some of the latest bathing and lift equipment features are, sources stressed that it's the basic equipment that's still most important.

“Equipment should be reliable and user-friendly for staff and safe and comfortable for residents,” Gansky reasons. “That's first and foremost. From there, you can start evaluating the [accessories] to see if they'll further drive improvements.”

“Will it improve resident outcomes? Will it help you comply with health and safety requirements? Will it increase operational efficiencies?” he says. “If a product can meet two of those [criteria] then it's worth considering. If it hits all three, then it's a no-brainer. If it can't meet two of those things, then don't bother—it's probably not worth the added expense.”

Drug substitutions saved the government $13 million last year, but more drug substitutions under Medicare Part B would have saved an additional $6 million, the Office of Inspector General for Health and Human Services concluded in a recent report to Congress.